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Mentor Form

Please note, all bolded fields are required.
   

Name:
Address:
Telephone Numbers:  
   
Home:
Work
Fax
E-mail address:

 

I am a:

FIU alumnus/a
FIU Parent
Friend of FIU


Degree/Year Major Institution:

1.
2.
3.
 

Please provide information about your current occupation below.

 

Position:

Company:
Address:

Description of your work:

 

Please list any other experience you have which would be useful in your role as a mentor (e.g. avid sailor, dog breeder, read mystery novels, etc...). This information helps students relate to mentors on a personal level.

 

How would you prefer to be contacted by students for the Mentor Directory (please check all that apply)?

 

Phone
Fax
Email

Additional comments or questions:
 

Which of the following mentoring programs interest you (please check all that apply):
 

Mentor Directory
E-Mentoring
Speak to Students on Campus